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Volume 14, Number 11—November 2008

Letter

Severe Malaria and Artesunate Treatment, Norway

Kristine MørchComments to Author , Øystein Strand, Oona Dunlop, Åse Berg, Nina Langeland, Rafael A.M. Leiva, Jørn-Åge Longva1, Håkon Sjursen, Steinar Skrede, Jon Sundal, and Mogens Jensenius
Author affiliations: Haukeland University Hospital, Bergen, Norway (K. Mørch, N. Langeland, R.A.M. Leiva, J.-A. Longva, H. Sjursen, S. Skrede); Akershus University Hospital, Nordbyhagen, Norway (Ø. Strand); Ullevål University Hospital, Oslo, Norway (O. Dunlop, M. Jensenius); Stavanger University Hospital, Stavanger, Norway (Å. Berg, J. Sundal);

Main Article

Table

Epidemiologic, clinical, and laboratory data from 9 patients with severe falciparum malaria treated with intravenous artesunate, Norway, 2006–2008*

Patient no. (gender/
age, y) Reason
for travel Country
of disease acquisition WHO severe malaria
criteria Days from symptom onset to therapy Initial
treatment Length of
hospital
stay, d
Parasitemia level, %
Day 0 Day 1 Day 2 Day 3 Day 4
1 (M/37) Tourism Ghana Impaired consciousness, bilirubin† 53, hyperparasitemia 10 AS + D 4 <1 0‡ 4
2 (M/45) VFR Mali Hyperparasitemia 4 AS + D 5 <1‡ <1 NA 0 4
3 (M/25) VFR Ghana Impaired consciousness, hematemesis, hemoglobinuria, lactate 3.2,§ hyperparasitemia 5 AS + D 15 7 <1 0‡ 3
4 (M/41) Tourism Ghana Coma, shock, hemoglobinuria, bilirubin 241, hyperparasitemia 5 AS + D 20 3 <1 NA 0‡ 5
5 (F/32) Immigration Nigeria Impaired consciousness, bilirubin 50, hyperparasitemia 3 AS + C
(patient pregnant) 7 0 NA‡ 3
6 (M/46) Business Nigeria Impaired consciousness, creatinine† 309, bilirubin 58, hyperparasitemia 6 Quinine 1,200 mg loading dose, then AS + D 30 5 0.5‡ 0 7
7 (M/35) Tourism Myanmar Impaired consciousness, hyperparasitemia 10 AS 4 <1 0‡ 0 5
8 (F/38) VFR Liberia Shock 7 AS + D 1 <1‡ 0 0 3
9 (M/55) VFR Guinea Creatinine 315, bilirubin 118, hyperparasitemia 4 AS + D 6 <1 0‡ 4

*WHO, World Health Organization; AS, artesunate; D, doxycycline; VFR, visiting friends and relatives; NA, not available; C, clindamycin.
†µmol/L (bilirubin reference range 5–25; creatinine reference range 60–105).
‡Day when intravenous artesunate was discontinued.
§mmol/L (reference range 0.5–2.2).

Main Article

1Current affiliation: Aalesund Hospital, Aalesund, Norway.

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